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Abstract
Gender bias has implications in the treatment of both male and female patients and it is important to take into consideration in most fields of medical research, clinical practice and education. Gender blindness and stereotyped preconceptions about men and women are identified as key causes to gender bias. However, exaggeration of observed sex and gender differences can also lead to bias. This article will examine the phenomenon of gender bias in medicine, present useful concepts and models for the understanding of bias, and outline areas of interest for further research.
... In medicine, gender biases are caused by gender blindness and by stereotyped preconceptions about men and women. 64 Gender stereotypes are acquired in society and are based on perceived gender roles, identities, and portrayals 64,65 ; which may have a negative impact on diagnosis and management because they lead to differences in treatment between women and men patients that are not clinically justified. Gender blindness, on the other hand, is the inability to recognize differences that are clinically pertinent, such as by assuming that the research findings obtained using only male subjects can be applied to women. ...
... In medicine, gender biases are caused by gender blindness and by stereotyped preconceptions about men and women. 64 Gender stereotypes are acquired in society and are based on perceived gender roles, identities, and portrayals 64,65 ; which may have a negative impact on diagnosis and management because they lead to differences in treatment between women and men patients that are not clinically justified. Gender blindness, on the other hand, is the inability to recognize differences that are clinically pertinent, such as by assuming that the research findings obtained using only male subjects can be applied to women. ...
... Gender blindness, on the other hand, is the inability to recognize differences that are clinically pertinent, such as by assuming that the research findings obtained using only male subjects can be applied to women. 64,65 Before completing our class, most students saw societal expectations and OB/ GYN visits as primarily responsible for women's more frequent visits to the doctor. Societal expectations referred to a "macho attitude" explaining men's reluctance to go to the doctor, unless conditions or symptoms are hard to ignore, while women are more likely to admit weakness and are more "attuned to their bodies" and hence more prone to visit their doctor. ...
OBJECTIVES: Sex and gender have profound effects on disease prevalence, presentation, and outcome, but these issues are not covered in depth in standard medical school curricula. To improve understanding of women's health, an intensive 1-month class was offered to fourth-year medical students. METHODS: The class combined background lectures on the biological and social determinants of women's health with presentations on specific medical conditions by practicing clinicians and students. Students' anonymous responses to end-of-class evaluation used by Stony Brook University School of Medicine as well as pre-and post-class answers to the question "why are women twice as likely to go to the doctor" were analyzed using quantitative, descriptive, and qualitative approaches. RESULTS: The class was given between 2017 and 2022 to a total of 154 students. Course evaluations were submitted by 133 students. Over 80% of responders ranked the class as good or excellent and many expressed surprise about how much sex and gender influence health. Furthermore, before taking the class responders favored gender stereotypes (82%) and OB/GYN visits (56%) as the main reasons why women utilize healthcare more often than men, whereas only 31% of post-class answers included these factors (p < .0001), which were replaced by others including misdiagnosis, high rate of adverse effects of medications, implicit bias, and longevity. CONCLUSION: A dedicated class given to students at the end of their undergraduate medical training increased awareness and knowledge of the effects of sex and gender on women's health.
... Gender norms in SHC have been described as affecting patients' perception of SHC as gendered (17). Gender bias in medicine and healthcare can negatively impact interaction between patients and HCPs, attitudes of HCPs, clinical decision-making, the design of research and the mediation of medical knowledge (70)(71)(72)(73). It has been suggested that healthcare functions as an institution that has the power to determine what is considered healthy behaviour in society (74) and that institutionalised social structures in healthcare can create and reproduce gendered health inequalities (64). ...
... Gender biased attitudes and attitudes based on idealised or stereotypical gender norms among HCPs may influence the care provided (70,75,111). It has been argued that HCPs can mediate or counteract gendered structures in healthcare (82). ...
... It has been argued that denying the impact of gender by claiming gender neutrality in healthcare can be a "particularly powerful way of doing gender" (75), as doing so risks dismissing or obscuring gender-related inequalities. HCPs' gender neutrality ambition and discourse can be interpreted as gender blindness, which is a form of gender bias that disregards the potential importance of gender in healthcare (70,153,154). The blindness approach to gender or to other social categories (e.g. ...
Aim: Healthcare professionals (HCP) have been described as vital for men’s experiences of sexual healthcare (SHC). However, HCPs in SHC have to a low extent been included in research on men and masculinity. The aim of this thesis was to explore HCPs’ attitudes, notions and discourses on men and masculinities in the SHC context. Notions about men and masculinities were explored in Study I. How HCPs construct gendered social location in SHC was explored in Study II. Methods: Data were gathered through seven focus group interviews (n=35) with HCPs working with men’s SHC at a primary healthcare clinic and at sexual health clinics in Sweden. HCPs notions of men and masculinities were analysed using qualitative content analysis. The construction of the gendered social location in SHC was analysed using critical discourse analysis. Results: In the analysis we identified that notions of men and masculinities were elusive and hard to grasp but easy to exemplify with normative, idealised and stereotypical masculinity. Further, men and masculinities seemed to be potentially challenging, and some types of masculinities were considered more challenging and situated further from the idealised masculinity. Experienced organisational deficiencies, lack of education and training on men’s sexual health and notions of men and masculinities appeared as interrelated. Moreover, we identified that masculinity was considered as something that should be disregarded to stay gender neutral in relation to patients in SHC and that notions of masculinities were situated in a context of personal and private relationships. Romantic and sexual preferences were used to describe preferable masculinity. In the analysis of how the gendered social location in SHC was constructed we found that SHC was positioned in opposition to masculinity in society, which was described as unconducive with SHC. Furthermore, HCPs’ discourses did not reflect a shared approach to men and masculinity and HCPs seemed to lack a shared professional discourse on masculinity. We identified compensatory strategies for the lack of professional discourse. Another finding was that SHC, as an arena, was construed as predominantly feminine in descriptions of its history, practice, staff and patients. The analysis identified that masculinity was constructed as a violation of norms and as a problem that men in SHC need help with. The discourses seemed to position HCPs as agents of change with a mission to transform masculinity, and men as reluctant patients that need extra efforts. Conclusion: The findings in this qualitative study indicate that HCPs balance private and professional notions of men and masculinities in SHC, and that the discourses on men and masculinities might lead to othering, rather than including, the diversity of men. A shared approach and professional discourse to men and masculinities could contribute to the creation of a more consistent and knowledge-based treatment of men. To achieve this and to manage the experienced organisational and educational challenges health system interventions are needed, including training and education on men’s sexual health, gender and masculinities. Future studies are needed to further explore HCPs’ experiences, and in particular, how HCPs’ attitudes, notions and discourses are associated with treatment seeking and satisfaction for men in need of SHC.
... Research into how gender bias in the health system influences the quality of cause of death statistics remains limited 22 . These biases can also impact population-level summary indicators, which are often used to develop and monitor progress in health, set targets, and develop strategies in national health plans 23 . ...
... Stereotypes-cognitive structures containing knowledge, beliefs, and expectancies about a social group (Hamilton & Trolier, 1986, p. 133)-particularly threaten the accuracy of critical judgments. Stereotypes involving sexual orientation (Eubanks-Carter & Goldfried, 2006;Mohr et al., 2009), gender (Hamberg, 2008;Travis et al., 2012), and race (Calabrese et al., 2014;van Ryn et al., 2006) have been shown to affect clinical diagnoses, often unconsciously and without malevolence (Dehon et al., 2017;FitzGerald & Hurst, 2017). ...
Introduction: This research investigates the possible role of racial and gender stereotypes in diagnosing children with Oppositional Defiant Disorder (ODD). ODD is diagnosed more readily in boys and Black children, although the factors producing differential diagnosis rates are unclear. The authors conducted six studies investigating the possibility that overlap between racial and gender stereotypes with ODD diagnostic criteria might contribute to gaps in its judged prevalence across groups. Method: Participants completed reverse correlation procedures to determine whether mental representations of children expected versus unexpected to be diagnosed with ODD differed in facial characteristics. Separate participants viewed these images and judged the likelihood that each person depicted had been diagnosed with ODD. Results: Classification images (CIs) showed that the children selected as having ODD appeared more prototypically Black in facial appearance than children not chosen as having ODD. No differences emerged in the gendered appearance of the two group-level CIs. Judged rates of ODD were higher for the children who appeared to be Black. However, diagnostic judgments of clinical trainees and practitioners were unaffected by appearance factors, suggesting that formal clinical training might attenuate the influence of stereotypes on judgment. Discussion: These results indicate that an overlap in Black stereotypes and diagnostic criteria for ODD might contribute to elevated diagnosis of ODD in African American children.
... Females are more often given false psychosomatic diagnoses, which may reflect the scarcity of research and deficient understanding of how the female body responds to biological illness [39]. It seemed that stereotyped preoccupations with men and women were identified as the main triggers of gender bias [40]. ...
Background: In medical practice, it is common to see patients who present with physical symptoms for which no disease pathology can be found. The presence of neurological symptoms that are shown to be incompatible with neurological pathophysiology is classically known as “conversion disorder” or “Functional Neurological Symptom Disorder” (FND). While FND is common in Egypt as in the rest of the world, few scientific studies systematically evaluate the degree of knowledge, attitude, and care provided by health care professionals to FND patients. We aimed to assess Egyptian physicians’ perspectives on FND.
Results: A cross-sectional study has been conducted on 152 physicians dealing with FND practicing in Egypt from specialties of psychiatry, neurology, and other specialties. We found that for 45% of the participants, disordered functioning of the nervous system plus psychogenesis was the accepted etiology behind FND. Most participants were significantly not satisfied with their education about FND (p-value 0.01). Psychiatrists and neurologists significantly preferred to use the term “conversion disorder” while other specialties mainly used “psychic” and “Somatization/Somatoform Disorder” (p-value 0.001). Forty-four percent of the participants think they have a good knowledge of functional neurological disorders (FND), while the majority (86.8%) were worried about missing an organic disorder. Psychiatrists were the most confident in diagnosing FND and the most comfortable discussing it with patients (p-values 0.055 and 0.007, respectively).
Conclusion: Here we highlight the common theme of worry about FND patients prevailing among healthcare professionals who are mostly perplexed about the mechanisms behind FND, and how to communicate these symptoms to other professionals and patients themselves. Future directions need to be devoted to minimizing the gap between the research finding and the currently applied care. Better education and teaching about FND may improve patient care
... We believe that our study highlights that despite progress in reducing gender bias in medicine [1], this bias continues to persist. We wanted to expand on previous studies that look at gender bias related to patients [14,15] and expand this concept to how important of an issue this is for the providers as well. We felt gender disparity would be most appropriate to evaluate in primarily elective-based specialties such as adult reconstruction and shoulder and elbow as patients often do have a choice in their surgeon. ...
Background Orthopedic surgery traditionally has been a male-dominant specialty with the lowest percentage of female residents and female faculty of all medical specialties. Prior studies demonstrate gender biases from both referring providers and patients. This study investigates surgeon, referring provider, and patient demographic differences in new patient orthopedic referrals. Methodology A retrospective chart review was performed to analyze the demographics of new patients referred to male and female orthopedic surgeons within adult reconstruction and shoulder/elbow specialties at a single academic institution. Patients and referring provider demographics were compared for male and female orthopedic surgeons. Statistical analysis utilized Student's t-test and chi-square analyses for quantitative and qualitative data, respectively. Results In total, 2,642 new patients were analyzed, with 2,084 patients being referred from a provider, and 306 patients requesting specific providers. When compared to male surgeons, female surgeons had fewer referrals from male providers (45.3% vs. 50.3%, p = 0.03) and no difference from female providers (30.6% vs, 29.9%, p = 0.72). The female adult reconstruction surgeon had fewer internal referrals compared to a male surgeon of similar experience and time at the institution (8.4% vs. 12.8%, p = 0.03). Female patients requested male surgeons more frequently than female surgeons (76.7% vs. 23.3%, p = 0.02). Conclusions New patient demographics differed between male and female orthopedic surgeons at a single academic institution with more male referring providers referring to male surgeons. Female patients requesting male orthopedic providers may reflect patient and specialty-driven biases. There remains a need for additional female representation in orthopedic surgery, and new patient referral patterns may be a marker to assess and monitor gender biases.
Literature has always been a key component in the development of children's linguistic skills as well as their moral awareness. This study will look at how literature can be used to teach gender awareness as well as other aspects of learning to literature students. A survey was conducted using a series of questions to learn about literature students' perceptions about the use of literature for emotional refinement. Based on the replies, a thorough evaluation has been conducted, and suggestions for classroom discussion, as well as the possibilities for further research, have been provided.
Heuristics, or mental shortcuts, are used by everyone to make decision making easier and quicker in daily life. In jobs such as medicine, however, using heuristics can lead to biased decision making and, in turn, misdiagnosis of patients. Doctors are not immune to being biased, or stereotyping. In fact, many healthcare professions have implicit bias training to try and minimize this. Knowledge about one’s own bias can make a difference short term, but the person will be thinking more about whether they are being biased and less on how they can solve the problem in front of them. Bias is, unfortunately, something that must be acknowledged in all corners of society. So, how do we accommodate our biases to get the best results — knowing that we will fall back on heuristics and stereotyping?
Falls are a leading cause of injury globally, and people with Parkinson’s disease are particularly at risk. An important step in reducing the probability of falls is to identify their causes, but manually classifying fall types is laborious and requires expertise. Natural language processing (NLP) approaches hold potential to automate fall type identification from descriptions. The aim of this study was to develop and evaluate NLP–based methods to classify fall types from Parkinson’s disease patient self-report data. We trained supervised NLP classifiers using an existing dataset consisting of both structured and unstructured data, including the age, gender, and duration of Parkinson's disease of the faller, as well as the fall location, free-text fall description, and fall class of each fall. We trained supervised classification models to predict fall class based on these attributes, and then performed an ablation study to determine the most important factors influencing the model. The best performing classifier was a hard voting ensemble model that combined the Adaboost, unweighted decision tree, weighted k-nearest neighbor, naïve Bayes, random forest, and support vector machine classifiers. On the testing set, this ensemble classifier achieved an F1-macro of 0.89. We also experimented with a transformer-based model, but its performance was subpar compared to that of the other models. Our study demonstrated that automatic fall type classification in Parkinson's disease patients is possible via NLP and supervised classification.KeywordsFallsNatural Language ProcessingText ClassificationParkinson’s disease
Despite the potential of AI in healthcare decision-making, there are also risks to the public for different reasons. Bias is one risk: any data unfairness present in the training set, such as the under-representation of certain minority groups, will be reflected by the model resulting in inaccurate predictions. Data drift is another concern: models trained on obsolete data will perform poorly on newly available data. Approaches to analysing bias and data drift independently are already available in the literature, allowing researchers to develop inclusive models or models that are up-to-date. However, the two issues can interact with each other. For instance, drifts within under-represented subgroups might be masked when assessing a model on the whole population. To ensure the deployment of a trustworthy model, we propose that it is crucial to evaluate its performance both on the overall population and across under-represented cohorts. In this paper, we explore a methodology to investigate the presence of drift that may only be evident in sub-populations in two protected attributes, i.e., ethnicity and gender. We use the BayesBoost technique to capture under-represented individuals and to boost these cases by inferring cases from a Bayesian network. Lastly, we evaluate the capability of this technique to handle some cases of drift detection across different sub-populations.
KeywordsConcept DriftData BiasHealthcare models
Gender awareness in medicine consists of two at-titudinal components: gender sensitivity and gender-role ideology. In this article, the development of a scale to measure these attitudes in Dutch medical students is described. After a pilot study and a feasibility study, 393 medical students in The Netherlands responded to a preliminary instrument consisting of 82 items (response rate 61.3%). Reliability and validity were established. A gender awareness scale containing a gender sensitivity subscale (14 items), and gender stereotypes towards patients (11 items) as well as towards doctors (7 items) was developed. The instrument may be used for research purposes to evaluate gender awareness raising courses.
The feminist movement was from its start in the 19th century involved in the struggle for better health care for women. The first feminists aimed at better information on birth control and sexuality. The second feminist wave focused on the unequal division of power roles between men and women. A lot of the problems women experienced could be seen as a consequence of their subordinate role in society. At the end of the 1980s and in the 1990s, the discipline women and health or women and medicine was developed. In this introduction to the theme, the developments in this discipline are described. The starting points of the new discipline followed the principles of ‘women’s health care’. These principles can be summarized as the emphasis on control and autonomy by the patient, demedicalization, the importance of the psychosocial context of complaints, empowerment of women and good information and communication. The central issue of the article is: what is the actual scientific state of the art and what important changes have been made on the subject gender and health? The article ends with ideas for future research.
A n n e F a u s t o -S t e r l i n g The Bare Bones of Sex: Part 1—Sex and Gender H ere are some curious facts about bones. They can tell us about the kinds of physical labor an individual has performed over a lifetime and about sustained physical trauma. They get thinner or thicker (on average in a population) in different historical periods and in response to different colonial regimes (Molleson 1994; Larsen 1998). They can in-dicate class, race, and sex (or is it gender—wait and see). We can measure their mineral density and whether on average someone is likely to fracture a limb but not whether a particular individual with a particular density will do so. A bone may break more easily even when its mineral density remains constant (Peacock et al. 2002). 1 Culture shapes bones. For example, urban ultraorthodox Jewish ado-lescents have lowered physical activity, less exposure to sunlight, and drink less milk than their more secular counterparts. They also have greatly decreased mineral density in the vertebrae of their lower backs, that is, the lumbar vertebrae (Taha et al. 2001). Chinese women who work daily in the fields have increased bone mineral content and density. The degree of increase correlates with the amount of time spent in physical activity (Hu et al. 1994); weightlessness in space flight leads to bone loss (Skerry 2000); gymnastics training in young women ages seventeen to twenty-seven correlates with increased bone density despite bone resorption caused by total lack of menstruation (Robinson et al. 1995). Consider also some recent demographic trends: in Europe during the past thirty years, the number of vertebral fractures has increased three-to fourfold for women and more than fourfold for men (Mosekilde 2000); in some Thanks to the members of the Pembroke Seminar on Theories of Embodiment for a wonderful year of thinking about the process of body making and for their thoughtful response to an earlier draft of this essay. Credit for the title goes to Greg Downey. Thanks also to anonymous reviewers from Signs for making me sharpen some of the arguments. 1 Munro Peacock et al. write: "The pathogenesis of a fragility fracture almost always involves trauma and is not necessarily associated with reduced bone mass. Thus, fragility fracture should neither be used synonymously nor interchangeably as a phenotype for os-teoporosis" (2002, 303).
Gender awareness in medicine consists of two attitudinal components: gender sensitivity and gender-role ideology. In this
article, the development of a scale to measure these attitudes in Dutch medical students is described. After a pilot study
and a feasibility study, 393 medical students in The Netherlands responded to a preliminary instrument consisting of 82 items
(response rate 61.3%). Reliability and validity were established. A gender awareness scale containing a gender sensitivity
subscale (14 items), and gender stereotypes towards patients (11 items) as well as towards doctors (7 items) was developed.
The instrument may be used for research purposes to evaluate gender awareness raising courses.
It is conventional wisdom in medical sociology and social epidemiology that in industrialized societies men die earlier than women, but that women have poorer health than men. A number of explanations for these differences have been postulated and tested (for example, different biological risks, acquired risks, reporting biases and experiences of health care). Using two recent British data sets we find that the pattern of sex differences in morbidity is more complicated than the conventional wisdom often suggests. The direction and magnitude of sex differences in health vary according to the particular symptom or condition in question and according to the phase of the life cycle. Female excess is only consistently found across the life span for psychological distress and is far less apparent, or reversed, for a number of physical symptoms and conditions. Detailed inspection of papers on gender differences published in the last decade reveals that our findings are not unique, but that a relatively undifferentiated model of consistent sex differences has nevertheless continued to predominate in the literature. We believe that the topic of gender differences in health warrants periodic re-examination.
The field of gender-specific medicine examines how normal human biology and physiology differs between men and women and how the diagnosis and treatment of disease differs as a function of gender. This revealing research covers various conditions that predominantly occur in men as well conditions that predominantly occur in women. Among the areas of greatest difference are cardiovascular disease, mood disorders, the immune system, lung cancer as a consequence of smoking, osteoporosis, diabetes, obesity, and infectious diseases. The Second Edition of Principles of Gender-Specific Medicine will decrease in size from two to one volume and focus on the essentials of gender-specific medicine. In response to the market as well as many of the reviewers' suggestions, the Editor has eliminated approximately 55 chapters from the first edition to make the book more compact and more focused on the essentials of gender-specific medicine. The content will be completely updated, redundant sections and chapters will be merged with others that are more relevant to the current study of sex and gender differences in human physiology and pathophysiology. Editor has eliminated approximately 55 chapters from the first edition to make the book more compact and more focused on the essentials of gender-specific medicine. Longer bibliographies and suggested reviews/papers of particular relevance and importance will be added at the end of each section. Each author will be asked to include recent meta-analysis of data Each chapter will progress translationally from the basic science to the clinical applications of gender-specific therapies, drugs, or treatments Section on drug metabolism will be eliminated but the subject will be incorporated into each relevant chapter Section on aging will be eliminated but age will be considered as a variable in each of the separate chapters.
The purpose of this article is to advance a new understanding of gender as a routine accomplishment embedded in everyday interaction. To do so entails a critical assessment of existing perspectives on sex and gender and the introduction of important distinctions among sex, sex category, and gender. We argue that recognition of the analytical independence of these concepts is essential for understanding the interactional work involved in being a gendered person in society. The thrust of our remarks is toward theoretical reconceptualization, but we consider fruitful directions for empirical research that are indicated by our formulation.
RECENT evidence has raised concerns that women are disadvantaged because of inadequate attention to the research, diagnosis, and treatment of women's health care problems. In 1985, the US Public Health Service's Task Force on Women's Health Issues reported that the lack of research data on women limited understanding of women's health needs.1
One concern is that medical treatments for women are based on a male model, regardless of the fact that women may react differently to treatments than men or that some diseases manifest themselves differently in women than in men. The results of medical research on men are generalized to women without sufficient evidence of applicability to women.2-4 For example, the original research on the prophylactic value of aspirin for coronary artery disease was derived almost exclusively from research on men, yet recommendations based on this research have been directed to